Basic Information
| Provider Information | |||||||||
| NPI: | 1548340508 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDO | ||||||||
| FirstName: | GRETCHEN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCAT, ATR-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 QUAKER HIGHLANDS RD | ||||||||
| Address2: | |||||||||
| City: | PERU | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129725179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5186436626 | ||||||||
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| Practice Location | |||||||||
| Address1: | 63 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | PLATTSBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129013315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185638000 | ||||||||
| FaxNumber: | 5185639001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 221700000X | 000805-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist |
ID Information
| ID | Type | State | Issuer | Description | 00805-1 | 01 | NY | NYS EDUC DEPT REGISTRATIO | OTHER |